Quality management in service activities

The function of quality is gaining in importance and quality is becoming a basic factor in the survival and development of the company. Due to the need to ensure that their organization, product or service is of consistent quality, companies introduce QM (Quality Management) into their business. Quality on the one hand is a set of properties, and on the other hand, it is about meeting the needs and expectations of customers. Quality management is an ongoing process, which is evolving and changing with the aim of ensuring the projected quality of the product or service is provided as successfully and objectively as possible. In doing so, companies use various tools and methods that enable the identification of key factors that have a decisive influence on ensuring the required quality of a product and/or service. The main goal of this paper is to present the properties, characteristics and ways of measuring the quality of services as well as how the companies engaged in services industry manage quality. Since the end of the 20th century, more and more attention is paid to the quality of services, and the main conclusion from the management point of view is that it is necessary to acquire new and retain existing customers, where the quality of products and services is crucial in this process

Somatic mutations of isocitrate dehydrogenases 1 and 2 are prognostic and follow-up markers in patients with acute myeloid leukaemia with normal karyotype

Background. Mutations in the isocitrate dehydrogenase 1 and 2 (IDH1 and IDH2) genes are frequent molecular lesions in acute myeloid leukaemia with normal karyotype (AML-NK). The effects of IDH mutations on clinical features and treatment outcome in AML-NK have been widely investigated, but only a few studies monitored these mutations during follow-up. Patients and methods. In our study samples from 110 adult de novo AML-NK were studied for the presence of IDH1 and IDH2 mutations, their associations with other prognostic markers and disease outcome. We also analyzed the stability of these mutations during the course of the disease in complete remission (CR) and relapse. Results. IDH mutations were found in 25 (23%) patients. IDH+ patients tend to have lower CR rate compared to IDH-patients (44% vs 62.2%, p = 0.152), and had slightly lower disease free survival (12 months vs 17 months; p = 0.091). On the other hand, the presence of IDH mutations had significant impact on overall survival (2 vs 7 months; p = 0.039). The stability of IDH mutations were studied sequentially in 19 IDH+ patients. All of them lost the mutation in CR, and the same IDH mutations were detected in relapsed samples. Conclusions. Our study shows that the presence of IDH mutations confer an adverse effect in AML-NK patients, which in combination with other molecular markers can lead to an improved risk stratification and better treatment. Also, IDH mutations are very stable during the course of the disease and can be potentially used as markers for minimal residual disease detection

Uloga regionalne anestezije u postoperativnoj analgeziji pedijatrijskih bolesnika

Introduction/Objective Pain is a disturbing experience associated with existing or potential tissue damage, with a sensory, emotional, cognitive, and social component. The aim of this study was to show the efficiency of regional anesthetic techniques in postoperative pain in children. Methods The retrospective cohort study was conducted on a group of 564 pediatric patients during the period from 2013 to 2016. Types of regional anesthesia were classified into the following six groups: caudal, epidural, spinal block, upper limb blocks, lower limb blocks, and truncal nerve block. From statistical methods, we used descriptive statistical methods of absolute and relative numbers, measurements of variability, central tendencies for numerical features, and methods of inferential statistics. We used the ch2 test for the attributive features of observations. Results In relation to the postoperative time when an analgesic was required, a statistically significant difference was observed in the age of children (p = 0.000), disease diagnosis (p = 0.000), type of block (p = 0.000), type of local anesthetic (p = 0.000), and type of anesthesia or sedation preoperatively (p = 0.005). Conclusion Postoperative analgesia was most needed by older children and children who were awake during surgery. Children with injuries and tumors need postoperative analgesia the earliest. The longest postoperative analgesia was recorded in patients who received caudal block. The longest postoperative analgesia can be seen in patients who received levobupivacaine, bupivacaine or levobupivacaine combined with lidocaine to perform the block.Uvod/Cilj Bol predstavlja uznemirujuće iskustvo koje je povezano sa postojećim ili mogućim oštećenjem tkiva, sa senzornom, emocionalnom, kognitivnom i socijalnom komponentom. Cilj ove studije je prikaz efikasnosti tehnika regionalne anestezije na postoperativni bol kod dece. Metode Retrospektivna kohortna studija je sprovedena na grupi od 564 pedijatrijskih bolesnika u periodu od 2013. do 2016. godine. Vrste regionalne anestezije su klasifikovane u šest grupa: kaudalna, epiduralna, spinalna, blokovi gornjih ekstremiteta, donjih ekstremiteta i blok trupa. Od statističkih metoda koristili smo deskriptivne statističke metode apsolutnih i relativnih brojeva za atributivna obeležja posmatranja, mere varijabiliteta, centralne tendencije za numerička obeležja i metode inferencijalne statistike. Izbor testova za numerička obeležja posmatranja zavisiće od raspodele podataka. Za atributivna obeležja posmatranja koristili smo ch2 test. Rezultati U odnosu na postoperativno vreme kada je bio potreban analgetik, statistički značajna razlika uočena je u uzrastu dece (p = 0,000), dijagnozi bolesti (p = 0,000), vrsti bloka (p = 0,000), vrsti korišćenog lokalnog anestetika (p = 0,000), kao i vrsti perioperativne anestezije ili sedacije (p = 0,005). Zaključak Postoperativna analgezija je najpotrebnija starijoj deci i deci koja su bila budna tokom hirurške intervencije. Najranija postoperativna analgezija je potrebna deci sa povredama i tumorima. Najduža postoperativna analgezija je zabeležena kod bolesnika koji su dobili kaudalni blok, kao i bolesnika koji su primili levobupivakain, bupivakain ili levobupivakain u kombinaciji sa bupivakainom za izvođenje bloka

Prognostic significance of cebpa mutations in patients with normal-karyotype - acute myeloid leukemia

Introduction: CEBPA gene encodes a transciptional factor with an essential role in granulocyte differentiation process. In acute myeloid leukemia (AML), mutationsin CEBPA gene have been associated with favorable outcome and up to now only the presence of double mutated CEBPA gene (CEBPAdm) was included in WHO classification. Prognostic influence of CEBPA mutationsin C-terminal (bZIP) region recently have been proposed as a marker for better overalsurvival (OS), higher probability of achieving complete remission (CR) and a lower risk of relapse. Since AML with normal karyotype (AML-NK) is a group with intermediate prognosis with the need for new prognostic markers, we analyzed the influence of bZIP CEBPA mutations as an additional molecular marker in Serbian AML-NK patients. Methods: CEBPA mutational screening was performed using a multiplex polymerase chain reaction– based fragment length analysis. A total of 61 bone marrow samples were collected from de novo AMLNK patients. Results: In our analysis, frequency of CEBPA mutations in Serbian AML-NK patients was 15% (12/61 patients). Six out of 12 patients had mutation in bZIP region (CEBPAbZIP+). All six CEBPAbZIP+ patients (100%) achieved CR after induction chemotherapy versus 62% of CEBPAbZIP- patients. CEBPAbZIP+ patients showed a significantly longer OS (CEBPAbZIP+ 31.5 months vs CEBPAbZIP- 10 months) and disease free survival (DFS) (CEBPAbZIP+ 30 months vs CEBPAbZIP- 10.5 months). Conclusion: Our analysis of Serbian AML-NK patients showed CEBPAdm was not associated with better prognosis but our results indicate that CEBPAbZIP+ status is a good candidate for a prognostic molecular marker

Wilms tumor (wt)1 gene expression in children with acute leukemia in Serbia

Acute leukemias constitute the most common malignancy in childhood, accounting for 25-35% of all cancer in children. They are divided into acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Genetic susceptibility is known to play a major role in childhood leukemias. Wilms tumor (WT)1 is a zinc finger transcription factor involved in regulating the process of cell differentiation; it has been implicated in a wide range of human neoplasms. WT1 overexpression in the bone marrow at diagnosis is reported to be an independent negative prognostic factor in adults and children with AML. The aim of the present investigation was to determine the expression of WT1 in the bone marrow of children with AML and ALL in Serbia and its possible impact on patient survival. We determined bone marrow WT1 expression levels by reverse -transcription polymerase chain reaction (RT-PCR) at diagnosis in 20 children with AML and 20 children with ALL (16 B-ALL and 4 T-ALL), as well as 15 age- and sex-matched controls who were evaluated for immune thrombocytopenic purpura (ITP). For children with AML, follow-up samples were also analyzed one month after treatment initiation and at variable later timepoints of control punctures. The results were normalized based on WT1 expression in controls. We found that children with AML had significantly higher WT1 expression at diagnosis (median SD: 139.42 244.03) than those with ALL (1.18 54.37; Mann -Whitney U=82; p lt 0.01) and ITP (0.76 1.01; U=32; p lt 0.01). Patients with T-ALL had higher WT1 expression than those with B-ALL, though significance was not reached due to subgroup size; differences between AML subgroups according to the French-American-British (FAB) classification were also below the level of significance, though a tendency toward higher values in M3 and M4 leukemias was notable. There was also a tendency toward higher values in 14 children with AML who were still alive after a median follow-up of 1.5 years (181.42 192.52) than in 6 who succumbed to the disease (104.29 354.87). All children with AML who had WT1 expression 1 month after diagnosis below the fourth quartile (10 of 10) were still alive, while only 2 of 5 with 1 -month WT1 expression in the fourth quartile survived (Fisher's exact test: p=0.0952). Taken together, our results support a role for WT1 in the diagnostic workup in children with acute leukemia, although it needs to be considered in view of a complex and indvidualized context

Kserofilne mikopopulacije izolovane iz semena uljane repice

This paper presents the results of an investigation related to mycological populations of rapeseed samples produced in the Institute of Field and Vegetable Crops in Novi Sad (location: Rimski Šančevi, Novi Sad), with a special emphasis on the potentially toxigenic mycopopulations. Mycological investigations were performed on the samples that were treated with 4% solution of Na-hypochlorite, and on the ones that were not submitted to this treatment. Isolation and determination of total mould count was carried out using Dichloran Glycerol Agar (DG18). The identification of isolated moulds was done according to modern keys for fungal determination. From 20 untreated tested samples, 17 were contaminated with moulds (10.0 to 4.7x102 cfu/g). When the samples were treated with 4% solution of Na-hypochlorite, moulds were isolated only form 4 samples, and the total mould count ranged from 10.0 to 60.0 cfu/g. In the isolated mycopopulations, xerophilic moulds dominated, especially those from the genera Aspergillus, Eurotium and Penicillium. In the isolated mycopopulations, high degree of isolated species belonged to toxigenic species from the genera Alternaria, Aspergillus, Fusarium, Eurotium and Penicillium.U radu su data istraživanja vezana za mikološku populaciju u uzorcima uljane repice proizvedene u Institutu za ratarstvo i povrtarstvo (lokacija Rimski Šančevi, Novi Sad), sa posebnim osvrtom na potencijalno toksigenu mikopopulaciju. Mikološka ispitivanja su izvedena u uzorcima koji su tretirani sa Na-hipohloritom, kao i u uzorcima koji nisu podvrgnuti ovom tretmanu. Izolacija i određivanje ukupnog broja plesni izvedeno je na Dixloran Glicerol agaru. Identifikacija izolovanih vrsta plesni izvedena je prema ključevima za determinaciju koji su opisani u literaturi. Od 20 ispitanih uzoraka u 17 je utvrđeno prisustvo plesni i ukupan broj se kretao do 10 do 4,7x102 cfu/g. Kada su uzorci tretirani 4% rastvorom Na-hipohlorita plesni su izolovane iz 4 uzorka, a ukupni broj plesni se kretao od 10,0 do 60,0 cfu/g. U izolovanoj mikopopulaciji dominirale su kserofilne vrste iz rodova Aspergillus, Eurotium i Penicillium. Izolovanu mikopopulaciju u visokom procentu činile se potencijalne toksigene vrste iz rodova Alternaria, Aspergillus, Fusarium, Eurotium i Penicillium

The influence of BCL2, BAX, and ABCB1 gene expression on prognosis of adult de novo acute myeloid leukemia with normal karyotype patients

Background: Deregulation of the apoptotic process underlies the pathogenesis of many cancers, including leukemia, but is also very important for the success of chemotherapy treatment. Therefore, the gene expression profile of main apoptotic factors, such as anti-apoptotic BCL2 (B-cell lymphoma protein 2) and pro-apoptotic BAX (BCL2-associated X), as well as genes involved in the multi-drug resistance (ABCB1), could have significant impact on the prognosis and could be used as targets for specific therapy.Patients and methodsWe analyzed the expression of BCL2, BAX, and ABCB1 in bone-marrow samples collected at diagnosis from 51 adult patients with acute myeloid leukemia with normal karyotype (AML-NK) using real-time polymerase chain reaction method, and examined their prognostic potential.ResultsIncreased expression of BCL2 (BCL2+) was associated with the presence of chemoresistance (p = 0.024), while patients with low BAX expression were more prone to relapse (p = 0.047). Analysis of the combined effect of BCL2 and BAX expression showed that 87% of patients with BAX/BCL2low status were resistant to therapy (p = 0.044). High expression of ABCB1 was associated with BCL2+ status (p < 0.001), and with absence FLT3-ITD mutations (p = 0.019).ConclusionsThe present analysis of BCL2, BAX, and ABCB1 gene expression profiles is the first study focusing solel

Expression levels of BCL2, BAX and MDR1 as pharmacotranscriptomic and prognostic markers of prognosis in acute myeloid leukemia

Acute myeloid leukemia (AML) is a malignancy of hematopoetic tissue which occurs due to a halt in differentiation, loss of proliferation control and dysregulated apoptosis of myeloid progenitor cells. In many cancers, as well as AML, dysregulation of apoptosis constitutes the basis of pathogenesis and this phenomenon is important for chemotherapy success. Pharmacotranscriptomic markers of AML prognosis could be targets of specific therapy. The anti-apoptotic gene BCL2 (B-cell lymphoma protein 2), the pro-apoptotic BAX (BCL2-associated X) and genes involved in drug resistance, like MDR1 could have a significant impact on AML prognosis and therapy response. Bone-marrow samples at diagnosis were collected from 51 adult patients with AML-NK. Expressions of BCL2, BAX and MDR1 were analysed using the real-time polymerase chain reaction method. Statistical evaluation was performed. The presence of chemoresistance was found to be associated with overexpression of BCL2 (BCL2+) (p=0.018), while underexpression of BAX in patients has shown a greater affinity towards relapse (p=0.034). Evaluating the expressions of BCL2 and BAX in a combined effect has shown that 87% of patients with BAX/BCL2low status were resistant to therapy (p=0.024). BCL2+ status was associated with high expression of MDR1 (p<0.001). Likewise, high expression of MDR1 was associated with the absence of NPM1 and FLT3-ITD mutations (p=0.048 and p=0.010, respectively). This is the first study that focused only on AML-NK patients, when it comes to analysis of BCL2, BAX and MDR1 gene expression profiles. The results of this preliminary study have shown that high BCL2 expression would likely lead to resistance from chemotherapy, making anti-BCL2 treatment a viable option in patients with this expression profile. A study on a larger group of patients could clarify the prognostic importance of the studied genes in adult AML-NK patients and improve the precision medicine approach in the field of hematology.Book of abstracts: International Conference of Biochemists and Molecular Biologists in Bosnia and Herzegovina - ABMBBIH May, 202

Comparative analysis of International Prognostic Index for chronic lymphocytic leukemia, progression-risk score, and MD Anderson Cancer Center 2011 score: A single center experience

Uvod/Cilj Prognoza hronične limfocitne leukemije (HLL) značajno je unapređena u poslednje vreme. Među nekoliko prognostičkih modela čiji je cilj predviđanje vremena do prve terapije (eng. TTFT) izdvajaju se skor rizika od progresije (eng. PRS) i skor Centra za rak MD Anderson iz 2011. God. (eng. MDACC 2011), dok se internacionalni prognostički indeks za HLL (eng. CLL-IPI), iako primarno ustanovljen za predikciju ukupnog preživljavanja (eng. OS), dobro pokazao i u predikciji TTFT. Cilj ovog rada je da se ispita značaj pomenutih prognostičkih modela u pogledu predviđanja TTFT i OS. Metode Analizirana kohorta je obuhvatila 57 neselektovanih bolesnika sa HLL Univerzitetskog kliničkog centra Srbije sa prosečno agresivnijim profilom bolesti u odnosu na opštu populaciju de novo bolesnika sa HLL. Bolesnici su ocenjivani prema navedenim skorovima uz analizu TTFT i OS. Rezultati Bolesnici sa višim vrednostima CLL-IPI, PRS i MDACC 2011 primili su prvu terapiju značajno ranije u poređenju sa bolesnicima sa nižim vrednostima ovih skorova (p = 0,002, p = 0,019 i p lt 0,001, redom). U multivarijantnoj analizi, MDACC 2011 i CLL-IPI su zadržali prognostički značaj u predikciji TTFT (p = 0,001, odnosno p = 0,018), dok je PRS ovaj značaj izgubio. CLL-IPI je bio jedini značajan prediktor OS u univarijantnoj (p = 0,005) i u multivarijantnoj analizi (p = 0,013). Zaključak CLL-IPI, PRS i naročito MDACC 2011 su dobri prediktori TTFT čak i u kohortama bolesnika sa agresivnijom bolešću, dok je za predikciju OS od ova tri prognostička modela CLL-IPI jedini primenljiv. Ovi rezultati pokazuju da bi prognostičke modele trebalo ispitati na bolesnicima sa HLL u različitim fazama bolesti, kakvi se sreću u realnoj kliničkoj praksi.Introduction/Objective Prognostication of chronic lymphocytic leukemia (CLL) has been substantially improved in recent times. Among several prognostic models (PMs) focused on the prediction of time to first treatment (TTFT), progression-risk score (PRS), and MD Anderson Cancer Center score 2011 (MDACC 2011) are the most relevant, while CLL-International Prognostic Index (CLL-IPI), although originally developed to predict overall survival (OS), is also being used to estimate TTFT. The aim of this study was to investigate CLL-IPI, PRS, and MDACC 2011 prognostic values regarding TTFT and OS. Methods The analyzed cohort included 57 unselected Serbian CLL patients from a single institution, with the basic characteristics reflecting more aggressive disease than in the general de novo CLL population. The eligible patients were assigned investigated PMs, and TTFT and OS analyses were performed. Results Patients with higher risk scores according to CLL-IPI, PRS, and MDACC 2011 underwent treatment significantly earlier than patients with lower risk scores (p = 0.002, p = 0.019, and p lt 0.001, respectively). In multivariate analysis, MDACC 2011 and CLL-IPI retained their significance regarding TTFT (p = 0.001 and p = 0.018, respectively), while PRS did not. CLL-IPI was the only significant predictor of OS both at the univariate (p = 0.005) and multivariate (p = 0.013) levels. Conclusion CLL-IPI, PRS, and particularly MDACC 2011 are able to predict TTFT even in cohorts with more advanced-disease patients, while for prediction of OS, CLL-IPI is the only applicable among the three PMs. These results imply that PMs should be investigated in more diverse CLL populations, as it is in real-life setting

Crown ethers reverse P-glycoprotein-mediated multidrug resistance in cancer cells

Multidrug resistance (MDR) is a widespread phenomenon exhibited by many cancers and represents a fundamental obstacle for successful cancer treatments. Tumour cells commonly achieve MDR phenotype through overexpression and/or increased activity of ABC transporters. P-glycoprotein transporter (P-gp, ABCB1) is a major cause of MDR and therefore represents a valuable target for MDR reversal. Several naturally occurring potassium ionophores (e.g. salinomycin) were shown to inhibit P-gp effectively. We have previously shown antitumour activity of a number of 18- crown-6 ether compounds that transport potassium ions across membranes. Here we present data on P-gp inhibitory activity of 16 adamantane-substituted monoaza- and diaza-18- crown-6 ether compounds, and their effect on MDR reversal in model cell lines. We show that crown ether activity depends on their lipophilicity as well as on the linker to adamantane moiety. The most active crown ethers were shown to be more effective in sensitising MDR cells to paclitaxel and adriamycin than verapamil, a well-known P-gp inhibitor. Altogether our data demonstrate a novel use of crown ethers for inhibition of P-gp and reversal of MDR phenotype